Senior Savvy: No pattern to progression of Alzheimer's disease

Wednesday

Jul 29, 2009 at 12:01 AMJul 29, 2009 at 9:14 AM

Q: My mother has Alzheimer's disease. Over the past few years the disease has progressed, but in the last three months I have seen a decline in my mother's ability to dress herself, care for herself and even feed herself. I find that my mother needs reminders to eat. She also has incontinence. Can Alzheimer's disease progress that rapidly?

Linda Sullivan and Debbie Gitner

Q: My mother has Alzheimer's disease. Over the past few years the disease has progressed, but in the last three months I have seen a decline in my mother's ability to dress herself, care for herself and even feed herself. I find that my mother needs reminders to eat. She also has incontinence. Can Alzheimer's disease progress that rapidly?

A: Yes it can. Alzheimer's disease can progress rapidly or progress slowly. There is no pattern to the way the disease progresses. It is unpredictable.

Alzheimer's disease affects the way someone is able to care for themselves and make decisions about themselves. As the disease progresses, changes occur such as what you are seeing: incontinence, needing more help with dressing and grooming, plus an increase in memory loss.

The middle stage of Alzheimer's disease can affect a person's ability to walk, and cause them to repeat the same stories or ask the same questions, talk but not always make sense, fidget with things, argue about tasks like taking a shower or changing, and sometimes leave the house to look for their house.

Some people have mood changes and become argumentative. They may bite or hit and push away caregivers or family. Other behaviors include thinking items are being stolen. They have poor decision-making skills and little safety awareness. It is also possible that now that your mother needs more care, you are seeing the changes that have been coming on slowly.

Q: My father has Parkinson's disease. It is becoming more difficult for him to care for himself, yet he is trying to stay as independent as possible. What should I be doing for him?

A: Parkinson's affects fine motor control. Some advice to allow your father to stay as independent as possible is to give him plenty of time to get himself dressed. Do not rush him. Many people with Parkinson's want to maintain their independence for as long as possible and can become angry at the caretaker if they feel they are trying to take over.

Try to purchase sneakers with Velcro closures. Remove buttons on clothes and replace them with Velcro fasteners. Sweat pants are easier to pull up and down.

If speaking is becoming difficult, put together a piece of paper with yes, no, bathroom and other words allowing your father to point to the words.

Contact your father's physician asking for a referral to the Visiting Nurse Association for an occupational therapy consultation. An occupational therapist can evaluate your father and offer other adaptive equipment ideas.

Q: My father has a fractured hip and end-stage dementia. He is unable to swallow food or take his pills by mouth. My father now requires total care with bathing, grooming and dressing. He is barely able to walk. My father is in severe pain and his orthopedist is suggesting hip surgery. His regular physician also suggests surgery to put in a feeding tube. I am overwhelmed with these decisions.

A: In these situations there is no right or wrong answer. Take a deep breath and review each situation separately.

Feeding tube: Did your father ever make any comments that he would want a feeding tube if he could no longer swallow? If there was no discussion about a feeding tube with your father then the decision is up to you if you are the health care agent.

Many people look at quality of life versus quantity of life. The decision is not easy but you must look at your father's current medical needs and his life to make this decision. Many people opt for a feeding tube and some people do not. It is truly a personal decision.

Next, ask yourself: What is the expected outcome of the hip surgery? Is it for pain relief? If your father was not walking well before the fractured hip, then it is unlikely he will walk after the hip surgery.

Another option to consider is hospice. Hospice is able to provide an expertise in pain control and allow your father to die with dignity. Medicare and many HMOs will pay for end-stage disease under the hospice benefit.

ElderCare Resource Services is a partnership of geriatric nurses and social workers that helps families to investigate, assess and recommend medical and non-medical care and resources for seniors. Send questions to SeniorSavvy@ElderCareResourceServices.com or ElderCare Resources Inc., 29 Gano Road, Marlborough, MA 01752, or call them at 508-879-7008.

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